AB0457 IMPROVED PREGNANCY OUTCOMES IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A RETROSPECTIVE STUDY OF PREGNANCIES FROM A SINGLE CENTER IN DENMARK FROM 2010-2020 COMPARED WITH THE PERIOD 1990-2010
Authors: M. Gohr, I. M. Jakobsen, R. B. Helmig, K. Stengaard-Pedersen, T. B. Laurberg, A. Troldborg
Journal: Annals of the Rheumatic Diseases (2022)

Background Over the past decades, the approach to follow and treat pregnant SLE patients has changed. Today it is recommended that pregnant patients are monitored closely in a multi-professional team throughout pregnancy (1). The importance of low disease activity before pregnancy and continued treatment during pregnancy has been established (2). Even though many improvements in the management of SLE pregnancies has been made, there is still a high risk of adverse pregnancy outcome (APO). Objectives We aimed to evaluate APO in a Danish SLE cohort followed from 2010-2020 and compare the results with a previous study cohort from the same referral area followed from 1990-2010 (3). Methods This retrospective cohort study used the local patient registry to identify pregnancies in SLE patients followed at the Department of Rheumatology, Aarhus University Hospital, Denmark from January 2010 to October 2020. All patients were followed regularly and fulfilled at least four of the 1997 American College of Rheumatology (ACR) criteria for SLE classification. Data included demographic, clinical, and laboratory data. Demographics included ethnicity, smoking habits, body mass index (BMI), and concomitant APS (recognized before pregnancy). Data were compared with data from a previous study (1990-2010) from the same department. Results In total, 66 pregnancies were registered in 41 women. APO occurred in 65 % of pregnancies. Forty-seven pregnancies resulted in a live birth, while 15 ended in miscarriage. Compared to the 1990-2010 cohort, a reduction in preterm deliveries (7.58 % vs. 17.9 %), acute caesarean (6.1 % vs. 15.5 %), and higher average birth weight (3045 g vs. 2870 g) were found (Table 1). Further, we observed more pregnancies and live births per year (Figure 1). A change in the approach to treatment was found, i.e., significantly more patients were treated with hydroxychloroquine (73 %) compared to the 1990-2010 cohort (6 %). Figure 1. Pregnancy outcome. Average number of pregnancies and live birth per year in the Aarhus SLE cohort in the period 1990-2010 compared with 2010-2020 Table 1. Maternal and fetal/neonatal adverse pregnancy outcomes in our study population (2010-2020) compared with previous study at Aarhus University Hospital (1990-2010). 1990-2010 n=84 2010-2020 n=66 p-value Pre-eclampsia/eclampsia, n (%) 7 (8.3) 8 (12.1) 0.59 HELLP syndrome, n (%) 4 (4.8) 0 - Gestational hypertension, n (%) 20 (23.8) 9 (13.6) 0.05 Preterm deliveries (&lt;37 th gestational week), n (%) 15 (17.9) 5 (7.58) 0.07 Acute caesarean delivery, n (%) 13 (15.5) 4 (6.1) 0.07 Elective caesarean delivery, n (%) 11 (13.1) 8 (12.1) - Total caesarean delivery, n (%) 24 (28.6) 12 (18.2) - Total fetal loss, n (%) 22 (26.2) 19 (28.8) 0.72 Spontaneous abortion &lt;22 weeks, n (%) 18 (21.4) 15 (22.7) 0.85 Therapeutic abortion 3 (3.6) 4 (6.1) 0.47 Still birth 1 (1.2) 0 - Fetal death after birth 2 (2.4) 0 - Birth weight, mean ± SD g 2870 (SD,NA) 3045 ± 611 - IUGR 10 (11.9) NA - SGA NA 12 (18.18) - Congenital heart block, n (%) 1 (1.2) 0 - Neonatal Lupus Syndrome, n (%) 2 (2.4) 0 - Conclusion Improvements in the frequency of APO were found in 2010-2020 compared with 1990-2010. However, even though a specialized multi-professional team closely follows pregnant women with SLE, pregnancy in SLE still carries a high risk of APO. References [1]Andreoli L et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017;76(3):476–85. [2]Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Vol. 8, Nature Reviews Rheumatology. Nature Publishing Group; 2012. p. 710–8. [3]Jakobsen IM et al. Maternal and foetal outcomes in pregnant systemic lupus erythematosus patients: an incident cohort from a stable referral population followed during 1990-2010. Scand J Rheumatol. 2015;44(5):377–84. Disclosure of Interests None declared